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Few Stroke Patients Given Clot-Buster Quickly Enough: Study
Date:2/11/2011

By Kathleen Doheny
HealthDay Reporter

THURSDAY, Feb. 10 (HealthDay News) Few eligible stroke patients get an injectable clot-busting drug within the recommended 60-minute window after their hospital arrival, new research finds.

"It has been widely recommended that the 'door-to-needle' time should be 60 minutes," said study author Dr. Gregg C. Fonarow, a professor of cardiovascular medicine at the University of California Los Angeles David Geffen School of Medicine. The phrase refers to the timeframe between when the patient arrives at the hospital and when that patient is given the clot-buster, known as tissue plasminogen activator (tPA).

In his analysis of stroke patients from 1,083 hospitals, he found the 60-minute window was not the typical reality. "That occurs only in 26.6 percent of patients," he said.

Fonarow was slated to present the findings Thursday at the American Stroke Association's International Stroke Conference in Los Angeles; the research is being published simultaneously in the journal Circulation.

Perhaps even more surprising, the hospitals in the study were all participating in the American Heart Association/American Stroke Association's Get with The Guidelines-Stroke quality improvement program, which recommends early tPA administration.

"It involved some of the largest, best-known hospitals for stroke care," Fonarow said.

The study looked at more than 25,500 patients who had suffered ischemic stroke -- in which a blood clot obstructs blood flow -- and had been treated with tPA within three hours of the start of symptoms.

Just 6,790 got the intravenous drug within 60 minutes. During the course of the study, there was only modest improvement in the hospitals' track records.

Fonarow's team found some differences in age, gender and race when it came to who got the drug quickly and who did not. "Older patients, women, blacks and Hispanics were less likely to be treated in a timely manner," he said.

He also found that experience mattered. Hospitals that treated a large number of stroke patients were more likely to administer the drug within that 60-minute window.

Those who got the drug in under 60 minutes were also less likely to die during their hospital stay than those who didn't. While only 8.6 percent of those who got the tPA within the ideal window died while in the hospital, 10.4 percent of those who got the drug less promptly did, the researchers said.

The results confirm other studies suggesting that busier stroke centers do better with stroke care, said Dr. Patrick Lyden, chief of neurology at Cedars-Sinai Medical Center in Los Angeles, who reviewed the findings but was not involved in the research.

The same has held true, he said, for heart surgery and hip replacement surgery. "Busier places do better," he said. "The next step is to get patients to the busiest stroke centers faster."

First approved by the U.S. Food and Drug Administration in 1996, tPA is used to treat ischemic stroke within the first three hours after the onset of symptoms, with certain conditions in a stroke patient ruling out its use. While doctors must decide who is and isn't a candidate for tPA, loved ones can do much to speed up treatment if a stroke occurs in a family member or friend, Fonarow said.

"Call 911 without delay," Fonarow said. Don't try to drive a patient to the hospital, he tells loved ones; rather, order an ambulance. Time lost is brain lost, Fonarow and other neurologists caution.

The Get with the Guidelines-Stroke program is supported in part by the American Heart Association Pharmaceutical Roundtable and the Bristol-Myers Squib/Sanofi Pharmaceutical Partnership. Fonarow reports receiving research support from the National Institutes of Health and serving as a consultant to Pfizer, Merck and other pharmaceutical companies.

More information

To learn more about tPA, visit the American Heart Association.

SOURCES: Gregg C. Fonarow, M.D., professor, cardiovascular medicine, University of California, Los Angeles, David Geffen School of Medicine; Patrick Lyden, M.D., chief, neurology, Cedars-Sinai Medical Center, Los Angeles; Feb. 10, 2011, presentation, American Stroke Association's International Stroke Conference 2011, Los Angeles; Feb. 10, 2011, Circulation


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